Interstate Licensure Compact for Physical Therapy

The Problem

The United States is an increasingly mobile society. The impact of this increasing mobility is keenly felt by individuals of professions licensed by the states, particularly those who must travel to multiple states to practice, sometimes at a moment's notice. Currently such individuals often must obtain multiple state licenses to practice. In addition, the increased use of telehealth as medium for the delivery of health care services has presented a conundrum for services delivered across state lines. The combination of increased mobility, changes to the health care system, changes to education (eg, internships and fellowships), and the rise of telehealth has highlighted the need for clinicians to have the ability to practice across jurisdictional boundaries with minimal barriers. As such, various licensed professions such as medicine, nursing, and EMS officials have increased efforts to improve licensure portability. One potential solution that would address both portability issues and allow for the use of telehealth across state lines is the concept of an interstate licensure compact.

What is an Interstate Compact?

According to the National Center for Interstate Compacts, interstate compacts are contracts between 2 or more states creating an agreement on a variety of issues, such as specific policy challenges, regulatory matters and boundary settlements. States have used interstate compacts to address a variety of issues—the most common and recognized interstate compact is your driver's license. For example, an individual issued a driver's license by the state of North Carolina is allowed to drive in other US jurisdictions provided that they follow the traffic safety laws of the jurisdiction in which they are driving. Interstate compacts make multistate licensure possible, while maintaining traditional state authority.

Creation of an interstate compact requires enactment of authorizing legislation from jurisdictions that wish to participate in an interstate compact. Such legislative language must be exactly the same in each state that adopts it; the compact is a legal agreement among the participating states and therefore must be uniform. The legislation is enacted by a state essentially makes the state a signatory to the interstate licensure compact agreement. However, it is important to note that only licensees whose primary place of residency is in a state participating in the interstate compact may use the benefits of the compact, and within only those states that are also participants in the interstate compact. For example, if California and Nevada are both participants in a hypothetical interstate compact for physical therapy, a licensee whose primary residence is in California could provide services via telehealth across state lines to a patient in Nevada. However, if the patient is in Texas, and Texas is not a participant of the interstate compact, then the California licensee would not be allowed to provide services to that patient. Learn more about what an interstate compact is and how it works via a free webinar courtesy of the Council of State Governments.

Development of an Interstate Compact for Physical Therapy

The issue of licensure compacts and portability in physical therapy was brought to the attention of the members of the Federation of State Boards of Physical Therapy (FSBPT) at their 2010 annual meeting with Delegate Assembly motion {DEL-10-05} directing the Federation Board of Directors "to explore the feasibility of establishing a multistate compact for physical therapy licensure…" Although not a formal motion, in 2011 the Delegate Assembly requested that FSBPT continue to research this topic and any results be communicated to the Assembly. The FSBPT Ethics and Legislative Committee then began exploring the topic of licensure portability, options for improved professional mobility within physical therapy, and potential licensure models. Meanwhile at the 2014 APTA House of Delegates Meeting, APTA adopted a position (.pdf) (See Principle VII) supporting licensure portability models including an interstate compact for physical therapy.

In 2014 FSBPT created a task force on exploring the feasibility of an interstate licensure compact for physical therapy. The task force consisted of stakeholders from across the country and included APTA staff and a representative from the APTA Board of Directors. The task force met twice in 2014 and was able to use the experience of other professions who either had developed or were in the process of developing a compact: The National Council of State Boards of Nursing (NCSBN), the Federation of State Medical Boards (FSMB), and the National Association of State EMS Officials (NASEMSO). The task force recommended that FSBPT move forward with the development of a compact. As a result, FSBPT, in coordination with the Council of State Governments' National Center for Interstate Compacts (CSG), appointed a "drafting team" composed of stakeholders, including APTA, that will begin the process of formulating the language for an interstate compact agreement. The compact language was finalized in the fall of 2015 and is now ready for use by APTA state chapters. It is this language – the Physical Therapy Licensure Compact, that states must uniformly enact via state legislation, without any changes or amendments, to become a member of the Physical Therapy Licensure Compact.